Prognosis And Convalescence

The duration of acute endocarditis varies greatly; it may be two or
three weeks, or the inflammation may become subacute and last for
several months. Although mild endocarditis rarely causes death of
itself, it may develop into an ulcerative endocarditis, and then be
serious per se. On the other hand, it may add its last quota of
disability to a patient already seriously ill, and death may occur
from the combination of disturbances. As soon as all acute symptoms
have ceased, rheumatic or otherwise, and the temperature is normal,
the amount of food should be increased; the strongly acting drugs
should be stopped; the alkalies, especially, should not be given too
long, and the salicylates should be given only intermittently, if at
all; iron should be continued, massage should be started, and iodid
should be administered, best in the form of the sodium iodid, from
0.1 to 0.2 gm. (1 1/2 to 3 grains), twice in twenty-four hours, with
the belief that it does some good toward promoting the resorption of
the endocardial inflammatory products and can never do any harm.
Prolonged bed rest must be continued, visitors must still be
proscribed, long conversations must not be allowed, and the return
to active mental and physical life must be most deliberate.

No clinician could state the extent to which the valvular
inflammation will improve or how much disability of the valves must
be permanent. It is even stated by some clinicians that a rest in
bed for three months is advisable. While this is of course
excessive, certainly, when the future health and ability of the
patient are under consideration, and especially when the patient is
a child or an adolescent, time is no object compared with the future
welfare of the person's heart. It is one of the greatest pleasures
of a the clinician to note such a previously inflamed heart
gradually diminish in size and the murmurs at the valves affected
gradually disappear. Although they may have disappeared while the
patient is in bed, he is not safe from the occurrence of a valvular
lesion for several months after he is up and about.

While the discussion of hygiene would naturally be confined to the
hygiene of the disease of which the endocarditis is a complication,
still the hygiene of its most frequent cause, rheumatism, should be
referred to. Fresh air and plenty of it, and dry air if possible, is
what is needed in rheumatism, and a shut-up, over-heated and
especially a damp room will continue rheumatism indefinitely. It is
almost as serious for rheumatism as it is for pneumonia. Sunlight
and the action of the sun's rays in a rheumatic patient's bedroom
are essential, if possibly obtainable.

As so many rheumatic germs are absorbed from diseased or inflamed
tonsils or from other parts of the mouth and throat, proper gargling
or swashing of the mouth and throat should be continued as much as
possible, even during an endocarditis. The prevention of mouth
infections will be the prevention of rheumatism and of endocarditis.